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Respuesta tardía al tratamiento anti-CGRP para la migraña
Oreste Marsico1, Marta Lioi2, Michele Trimboli3
1Department of Neuroscience, "Giovanni Paolo II" Hospital, Lamezia Terme, Catanzaro, Italy.
Pain management
|August 21, 2025
Resumen
Muchos pacientes con migraña se benefician de las terapias con péptidos relacionados con el gen de la calcitonina (CGRP), pero algunos responden más tarde de 3 meses. Para lograr un alivio significativo de la migraña, se necesita una duración prolongada del tratamiento de hasta 12 meses para estos pacientes con respuesta tardía y ultra-tardía.
Área de la Ciencia:
- Neurología
- Farmacología
- Medicina Clínica
Sus antecedentes:
- La migraña es un trastorno neurológico generalizado con un impacto global significativo.
- Los tratamientos preventivos existentes a menudo tienen una eficacia y tolerabilidad limitadas.
- Los anticuerpos monoclonales dirigidos al péptido relacionado con el gen de la calcitonina (CGRP) ofrecen una nueva vía terapéutica.
Objetivo del estudio:
- Revisar la ocurrencia de respuestas tardías y ultra-latas a la terapia anti-CGRP en pacientes con migraña.
- Explorar los mecanismos potenciales y la importancia clínica de las respuestas tardías al tratamiento.
- Evaluar la necesidad de prolongar la duración del tratamiento más allá de los 3 meses estándar.
Principales métodos:
- Se realizó una revisión narrativa de la literatura pertinente.
- Se realizó una búsqueda exhaustiva de la literatura en PubMed, Web of Science y Google Scholar.
- Se incluyeron estudios publicados hasta julio de 2025, centrados en datos del mundo real.
Principales resultados:
- Los estudios realizados en el mundo real indican que una proporción sustancial de pacientes que inicialmente no respondieron al tratamiento con anti-CGRP obtienen un beneficio clínico en momentos posteriores.
- Aproximadamente un tercio de los que no respondieron mejoraron a los 6 meses (los que respondieron tarde), y se observaron otros beneficios a los 12 meses (los que respondieron muy tarde).
- Se hipotetiza que los mecanismos centrales de desensibilización que involucran interacciones anti-CGRP subyacen a estas respuestas retrasadas.
Conclusiones:
- Un número significativo de pacientes con migraña experimentan respuestas retrasadas o ultra-retrasadas a las terapias anti-CGRP.
- La duración del tratamiento con anti-CGRP debe extenderse más allá de 3 meses para captar estos beneficios retrasados.
- Se necesitan más investigaciones sobre los mecanismos de respuesta tardía para optimizar las estrategias de manejo de la migraña.
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